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Al-Khreisat MJ, Ismail NH, Tabnjh A, Hussain FA, Mohamed Yusoff AA, Johan MF, Islam MA. Worldwide Prevalence of Epstein-Barr Virus in Patients with Burkitt Lymphoma: A Systematic Review and Meta-Analysis. Diagnostics (Basel) 2023; 13:2068. [PMID: 37370963 DOI: 10.3390/diagnostics13122068] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2023] [Revised: 05/28/2023] [Accepted: 06/07/2023] [Indexed: 06/29/2023] Open
Abstract
Burkitt lymphoma (BL) is a form of B-cell malignancy that progresses aggressively and is most often seen in children. While Epstein-Barr virus (EBV) is a double-stranded DNA virus that has been linked to a variety of cancers, it can transform B lymphocytes into immortalized cells, as shown in BL. Therefore, the estimated prevalence of EBV in a population may assist in the prediction of whether this population has a high risk of increased BL cases. This systematic review and meta-analysis aimed to estimate the prevalence of Epstein-Barr virus in patients with Burkitt lymphoma. Using the appropriate keywords, four electronic databases were searched. The quality of the included studies was assessed using the Joanna Briggs Institute's critical appraisal tool. The results were reported as percentages with a 95% confidence interval using a random-effects model (CI). PROSPERO was used to register the protocol (CRD42022372293), and 135 studies were included. The prevalence of Epstein-Barr virus in patients with Burkitt lymphoma was 57.5% (95% CI: 51.5 to 63.4, n = 4837). The sensitivity analyses demonstrated consistent results, and 65.2% of studies were of high quality. Egger's test revealed that there was a significant publication bias. EBV was found in a significantly high proportion of BL patients (more than 50% of BL patients). This study recommends EBV testing as an alternative for predictions and the assessment of the clinical disease status of BL.
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Affiliation(s)
- Mutaz Jamal Al-Khreisat
- Department of Haematology, School of Medical Sciences, Universiti Sains Malaysia, Kubang Kerian 16150, Kelantan, Malaysia
| | - Nor Hayati Ismail
- Department of Haematology, School of Medical Sciences, Universiti Sains Malaysia, Kubang Kerian 16150, Kelantan, Malaysia
| | - Abedelmalek Tabnjh
- Department of Applied Dental Sciences, Faculty of Applied Medical Sciences, Jordan University of Science and Technology, Irbid 22110, Jordan
| | - Faezahtul Arbaeyah Hussain
- Department of Pathology, School of Medical Sciences, Universiti Sains Malaysia, Kubang Kerian 16150, Kelantan, Malaysia
| | - Abdul Aziz Mohamed Yusoff
- Department of Neurosciences, School of Medical Sciences, Universiti Sains Malaysia, Kubang Kerian 16150, Kelantan, Malaysia
| | - Muhammad Farid Johan
- Department of Haematology, School of Medical Sciences, Universiti Sains Malaysia, Kubang Kerian 16150, Kelantan, Malaysia
| | - Md Asiful Islam
- WHO Collaborating Centre for Global Women's Health, Institute of Metabolism and Systems Research, College of Medical and Dental Sciences, University of Birmingham, Birmingham B15 2TT, UK
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Ndede I, Mining SK, Patel K, Wanjala FM, Chumba D, Tenge C. Cytokines associated with Burkitt's lymphoma in western Kenya. BMC Res Notes 2017; 10:519. [PMID: 29078819 PMCID: PMC5659020 DOI: 10.1186/s13104-017-2841-0] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2017] [Accepted: 10/23/2017] [Indexed: 12/26/2022] Open
Abstract
Objective Burkitt’s lymphoma (BL) is a common aggressive non-Hodgkin’s lymphoma in East and Central Africa among children. Persistent infections with Epstein Barr virus or Plasmodium falciparum are associated with immune hyperstimulation. It is hypothesised that inadvertent cytokine responses to infections indirectly or directly influence B cell neoplastic transformation through c-myelocytomatosis (c-myc) gene translocation. We sought to describe cytokines in children and adolescents with BL. Participants were recruited from western Kenya with parental consent, diagnosis confirmed using histology and consensus panel of immunohistochemistry antibodies. T helper1/2/17A and transforming growth factor-β1 (TGF-β1) cytokines were estimated using cytometric bead array in plasma. Complete blood counts (CBC) were determined by Beckman Coulter®. Results Out of 104 enrolled participants, 32% were confirmed BL and 68% grouped as non-BL. Mean (pg/ml) levels of cytokines in BL and non-BL were: interleukin (IL)-6 100.3 and 39.4 p = 0.152; IL-10 11.5 and 12.5 p = 0.363; IL-17A 17.8 and 64.9 p = 0.094 respectively. Expressions of interferon-γ, IL-2 and tumour necrosis factor-α were low and TGF-β1 undetectable in both groups. Mean CBC differed between the two groups before and after chemotherapy, WBC being significantly so. Interleukin-6, IL-17A and IL-10 responses to infections in the study area may be associated with pathogenesis and be potential therapeutic targets.
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Affiliation(s)
- Isaac Ndede
- Department of Immunology, Moi University School of Medicine, P. O. Box 4606, Eldoret, 30100, Kenya.
| | - Simeon K Mining
- Department of Immunology, Moi University School of Medicine, P. O. Box 4606, Eldoret, 30100, Kenya
| | - Kirtika Patel
- Department of Immunology, Moi University School of Medicine, P. O. Box 4606, Eldoret, 30100, Kenya
| | - Fredrick M Wanjala
- Department of Biological Sciences, University of Eldoret, Eldoret, Kenya
| | - David Chumba
- Department of Histopathology and Cytology, Moi University School of Medicine, Eldoret, Kenya
| | - Constance Tenge
- Department of Child Health and Paediatrics, Moi University School of Medicine, Eldoret, Kenya
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Epidemiology of Epstein-Barr virus-associated pediatric lymphomas from Argentina. BOLETIN MEDICO DEL HOSPITAL INFANTIL DE MEXICO 2016; 73:47-54. [PMID: 29421233 DOI: 10.1016/j.bmhimx.2015.12.002] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2015] [Accepted: 12/03/2015] [Indexed: 11/22/2022] Open
Abstract
More than 90% of the population is infected by Epstein-Barr virus (EBV), which has sophisticatedly evolved to survive silently in B cells for the life of infected individuals. However, if the virus-host balance is disturbed, latent EBV infection could be associated with several lymphomas. The age at primary infection varies substantially worldwide, and exposure to EBV is likely to be due to socioeconomic factors. In Argentina, EBV infection is mostly subclinical and 90% of patients are seropositive by the age of 3 years; therefore, its epidemiological characteristics resemble those of an underdeveloped or developing population. EBV-positive Hodgkin lymphoma (HL) in young adults from developed populations has been attributed to delayed primary EBV infection as suggested by the association with recent mononucleosis development. EBV-associated Burkitt lymphoma and Hodgkin lymphoma in children from Argentina display frequencies similar to those observed in developed countries, whereas EBV presence in pediatric diffuse large B-cell lymphoma is slightly increased compared to those populations. However, EBV presence is statistically associated particularly with patients < 10 years of age in all three entities. Therefore, a relationship between low age of EBV seroconversion and B-cell lymphoma development risk could be suggested in children from Argentina.
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Non-Hodgkin lymphoma in the Far East: review of 730 cases from the international non-Hodgkin lymphoma classification project. Ann Hematol 2015; 95:245-51. [PMID: 26537613 DOI: 10.1007/s00277-015-2543-4] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2015] [Accepted: 10/29/2015] [Indexed: 12/13/2022]
Abstract
Large and systematic studies of non-Hodgkin lymphoma (NHL) in the Far East (FE) with good comparative data are scarce in the literature. In this study, five expert hematopathologists classified 730 consecutive cases of newly-diagnosed NHL from four sites in the FE (excluding Japan) using the World Health Organization classification. The results were compared to 399 cases from North America (NA). We found a significantly higher male to female ratio in the FE compared to NA (1.7 versus 1.1; p < 0.05). The median ages of patients with low-grade (LG) and high-grade (HG) B-NHL in the FE (58 and 51 years, respectively) were significantly lower than in NA (64 and 68 years, respectively). The FE had a significantly lower relative frequency of B-NHL and a higher frequency of T-NHL (82 vs. 18 %) compared to NA (90.5 vs. 9.5 %). Among mature B cell lymphomas, the FE had a significantly higher relative frequency of HG B-NHL (54.8 %) and a lower frequency of LG B-NHL (27.2 %) than NA (34.3 and 56.1 %, respectively). Diffuse large B cell lymphoma was more common in the FE (49.4 %) compared to NA (29.3 %), whereas the relative frequency of follicular lymphoma was lower in the FE (9.4 %) compared to NA (33.6 %). Among T-NHL, nasal NK/T cell NHL was more frequent in the FE (5.2 %) compared to NA (0 %). Peripheral T cell lymphoma was also more common in the FE (9.1 %) than in NA (5.3 %). Further epidemiologic studies are needed to better understand the pathobiology of these differences.
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Onwubuya IM, Adelusola KA, Durosinmi MA, Sabageh D, Ezike KN. Lymphomas in Ile-Ife, Nigeria: Immunohistochemical Characterization and Detection of Epstein-Barr virus Encoded RNA. JOURNAL OF CLINICAL AND DIAGNOSTIC RESEARCH : JCDR 2015; 9:EC14-9. [PMID: 26266128 DOI: 10.7860/jcdr/2015/12085.6127] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 11/12/2014] [Accepted: 05/11/2015] [Indexed: 12/22/2022]
Abstract
BACKGROUND The proper histopathological characterization of malignant lymphomas requires the use of immunohistochemistry along with other molecular pathology techniques. MATERIALS AND METHODS Malignant lymphomas histologically diagnosed in our hospital were reclassified according to the WHO scheme using immunohistochemistry while in-situ hybridization was performed for the detection of Epstein-Barr virus encoded RNA. RESULTS There were 83 cases of lymphoma. The male to female ratio was 1.9:1 while the overall mean age was 41.7 years. Non-Hodgkin lymphomas (NHL) constituted about 79.5% of cases. The majority of cases (98.8%) were B-cell lymphomas. Nine subtypes of lymphomas were identified with diffuse large B-cell lymphomas (56.4% of which were of the germinal centre type) constituting the largest group (47.0%). Intermediate and high grade subtypes were more common. The majority of cases (72.3%) were nodal lymphomas with cervical lymph node being the commonest site (48.2%). Only classical Hodgkin lymphoma (HL) (20.5%) was seen of which the mixed cellularity subtype was the most common. Epstein Barr virus (EBV) encoded ribonucleic acid was detected in 7 cases (8.4%) including 4 cases of HL, 2 cases of Burkitt lymphoma and the only case of plasmablastic lymphoma. About five cases were reclassified as non-lymphoid malignant lesions. CONCLUSION Immunohistochemistry is vital to the proper classification of lymphomas even in a resource poor environment. Although nine subtypes of lymphomas were identified, diffuse large B-cell lymphomas formed the largest single group. Epstein-Barr virus probably plays an important role in lymphomatogenesis in this environment. A larger multicentre study is required to prove this.
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Affiliation(s)
- Ifeyinwa M Onwubuya
- Senior Registrar, Department of Morbid Anatomy and Forensic Medicine, Obafemi Awolowo University Teaching Hospitals Complex , Ile-Ife, Osun State, Nigeria
| | - Kayode A Adelusola
- Consultant Pathologist, Department of Morbid Anatomy and Forensic Medicine, Obafemi Awolowo University Teaching Hospitals Complex , Ile-Ife, Osun State, Nigeria
| | - Muheez A Durosinmi
- Consultant Haematologist, Department of Haematology and Blood Transfusion, Obafemi Awolowo University Teaching Hospitals Complex , Ile-Ife, Osun State, Nigeria
| | - Donatus Sabageh
- Consultant Pathologist, Department of Morbid Anatomy and Histopathology, Ladoke Akintola University of Technology Teaching Hospital , Ogbomoso, Oyo State, Nigeria
| | - Kevin N Ezike
- Consultant Pathologist, Department of Anatomic Pathology, Asokoro District Hospital , Abuja, Nigeria
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Cohen M, Narbaitz M, Metrebian F, De Matteo E, Preciado MV, Chabay PA. Epstein-Barr virus-positive diffuse large B-cell lymphoma association is not only restricted to elderly patients. Int J Cancer 2014; 135:2816-24. [PMID: 24789501 DOI: 10.1002/ijc.28942] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2013] [Accepted: 04/17/2014] [Indexed: 01/20/2023]
Abstract
Diffuse large B-cell lymphoma (DLBCL), the most common group of malignant lymphomas, account for 30% of adult non-Hodgkin lymphomas. The 2008 World Health Organization (WHO) classification included a new entity, Epstein-Barr virus (EBV)+ DLBCL of the elderly, affecting patients aged 50 years or older. However, some reports of younger EBV+ DLBCL cases, without evidence of underlying immunosuppression, can be found. The role of EBV in tumor microenvironment composition in DLBCL is still not well understood. Our aim was to assess EBV presence and latency pattern as well as tumor T-cell population in an adult DLBCL series of Argentina. The study was conducted on biopsies from 75 DLBCL patients. EBERs expression was performed by in situ hybridization, while EBV gene expression was analyzed using real-time polymerase chain reaction. LMP1, LMP2A, EBNA2, EBNA3A, CD4, CD8 and Foxp3 expression was assessed by immunohistochemistry. Nine percent of cases showed EBV expression, with similar frequency among patients younger than 50 years and 50 years or older (13% and 8%, respectively). T-cell subsets were not altered by EBV presence. Latency type II was the most frequently observed, together with lytic gene expression in EBV+ DLBCL, with ≥20% of EBERs+ cells. These findings suggest that EBV+ DLBCL in our series was similar to the previously described in Asia and Latin-America, displaying latency II or III expression profile and no age-specific characteristics. Finally, EBV+ DLBCL may be an entity that is not only restricted to patients who are older than 50 years of age, in consequence the age cutoff revision may be a current goal.
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Affiliation(s)
- M Cohen
- Molecular Biology Laboratory, Pathology Division, Ricardo Gutiérrez Children's Hospital, Buenos Aires, Argentina
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Cohen M, De Matteo E, Narbaitz M, Carreño FA, Preciado MV, Chabay PA. Epstein-Barr virus presence in pediatric diffuse large B-cell lymphoma reveals a particular association and latency patterns: analysis of viral role in tumor microenvironment. Int J Cancer 2012; 132:1572-80. [PMID: 22987474 DOI: 10.1002/ijc.27845] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2012] [Accepted: 08/31/2012] [Indexed: 01/29/2023]
Abstract
Non-Hodgkin's lymphoma represents 6-10% of pediatric malignancies, and diffuse large B-cell lymphoma (DLBCL) is one of the three major subtypes. The 2008 WHO classification included a new entity, Epstein-Barr virus (EBV)-positive DLBCL of the elderly, affecting patients >50 years. It has been demonstrated that EBV may play a role in tumor microenvironment composition, disturbing antitumor immune response and disease progression. As most studies were performed in adults, our aim was to assess EBV presence and latency pattern, as well as T-cell microenvironment in a pediatric DLBCL series of Argentina. The study was conducted on formalin-fixed paraffin-embedded biopsies from 25 DLBCL patients. EBV-encoded small nuclear early regions (EBERs) expression was performed by in situ hybridization, whereas EBV gene expression was analyzed using real-time PCR. Epstein-Barr virus latent membrane proteins (LMP)1, LMP2A, CD3, CD4, CD8 and Foxp3 expression were assessed by immunohistochemistry (IHC). Forty percent of cases showed EBV expression, with a significantly higher incidence among patients <10 years (p = 0.018), and with immunosuppressed (p = 0.023). T-cell subsets were not altered by EBV presence. Full EBV latency antigen expression (latency type III) was the most frequently pattern observed, together with BZLF1 lytic gene expression. One patient showed II-like pattern (LMP1 without LMP2A expression). Based exclusively on IHC, some patients showed latency II/III (EBERs and LMP1 expression) or I (EBERs only). These findings suggest that EBV association in our series was higher than the previously demonstrated for elderly DLBCL and that EBV latency pattern could be more complex from those previously observed. Therefore, EBV could be an important cofactor in pediatric DLBCL lymphomagenesis.
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Affiliation(s)
- Melina Cohen
- Molecular Biology Laboratory, Pathology Division, Ricardo Gutiérrez Children's Hospital, Buenos Aires, Argentina.
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Tumwine LK, Lalitha R, Agostinelli C, Luzige S, Orem J, Piccaluga PP, Osuwat LO, Pileri SA. Primary effusion lymphoma associated with Human Herpes Virus-8 and Epstein Barr virus in an HIV-infected woman from Kampala, Uganda: a case report. J Med Case Rep 2011; 5:60. [PMID: 21320326 PMCID: PMC3048476 DOI: 10.1186/1752-1947-5-60] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2010] [Accepted: 02/14/2011] [Indexed: 02/07/2023] Open
Abstract
INTRODUCTION Primary effusion lymphoma is a recently recognized entity of AIDS related non-Hodgkin lymphomas. Despite Africa being greatly affected by the HIV/AIDS pandemic, an extensive MEDLINE/PubMed search failed to find any report of primary effusion lymphoma in sub-Saharan Africa. To our knowledge this is the first report of primary effusion lymphoma in sub-Saharan Africa. We report the clinical, cytomorphologic and immunohistochemical findings of a patient with primary effusion lymphoma. CASE PRESENTATION A 70-year-old newly diagnosed HIV-positive Ugandan African woman presented with a three-month history of cough, fever, weight loss and drenching night sweats. Three weeks prior to admission she developed right sided chest pain and difficulty in breathing. On examination she had bilateral pleural effusions.Haematoxylin and eosin stained cytologic sections of the formalin-fixed paraffin-embedded cell block made from the pleural fluid were processed in the Department of Pathology, Makerere University, College of Health Sciences, Kampala, Uganda. Immunohistochemistry was done at the Institute of Haematology and Oncology "L and A Seragnoli", Bologna University School of Medicine, Bologna, Italy, using alkaline phosphatase anti-alkaline phosphatase method. In situ hybridization was used for detection of Epstein-Barr virus.The tumor cells were CD45+, CD30+, CD38+, HHV-8 LANA-1+; but were negative for CD3-, CD20-, CD19-, and CD79a- and EBV RNA+ on in situ hybridization. CD138 and Ki-67 were not evaluable. Our patient tested HIV positive and her CD4 cell count was 127/μL. CONCLUSIONS A definitive diagnosis of primary effusion lymphoma rests on finding a proliferation of large immunoblastic, plasmacytoid and anaplastic cells; HHV-8 in the tumor cells, an immunophenotype that is CD45+, pan B-cell marker negative and lymphocyte activated marker positive. It is essential for clinicians and pathologists to have a high index of suspicion of primary effusion lymphoma when handling HIV positive patients who have effusions without palpable tumor masses. Basic immunohistochemistry is essential for definitive diagnosis.
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Affiliation(s)
- Lynnette K Tumwine
- Department of Pathology, School of Biomedical Sciences, Makerere University College of Health Sciences, Mulago Hill Road, PO Box 7072, Kampala, Uganda.
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Tumwine LK, Orem J, Kerchan P, Byarugaba W, Pileri SA. EBV, HHV8 and HIV in B cell non Hodgkin lymphoma in Kampala, Uganda. Infect Agent Cancer 2010; 5:12. [PMID: 20591151 PMCID: PMC2907314 DOI: 10.1186/1750-9378-5-12] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2009] [Accepted: 06/30/2010] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND B cell non Hodgkin lymphomas account for the majority of lymphomas in Uganda. The commonest is endemic Burkitt lymphoma, followed by diffuse large-B-cell lymphoma (DLBCL). There has been an increase in incidence of malignant lymphoma since the onset of the HIV/AIDS pandemic. However, the possible linkages of HHV8 and EBV to the condition of impaired immunity present in AIDS are still not yet very clearly understood. OBJECTIVES 1. To describe the prevalence of Epstein-Barr virus, Human Herpes virus 8 and Human Immunodeficiency Virus-1 in B cell non Hodgkin lymphoma biopsy specimens in Kampala, Uganda.2. To describe the histopathology of non Hodgkin lymphoma by HIV serology test result in Kampala, Uganda METHOD Tumour biopsies specimens from 119 patients with B cell non Hodgkin lymphoma were classified according to the WHO classification. Immunohistochemistry was used for detection of HHV8 and in situ hybridization with Epstein Barr virus encoded RNA (EBER) for EBV. Real time and nested PCR were used for the detection of HIV.The patients from whom the 1991-2000 NHL biopsies had been taken did not have HIV serology results therefore 145 patients biopsies where serology results were available were used to describe the association of HIV with non Hodgkin lymphoma type during 2008-2009. RESULTS In this study, the majority (92%) of the Burkitt lymphomas and only 34.8% of the diffuse large B cell lymphomas were EBV positive. None of the precursor B lymphoblastic lymphomas or the mantle cell lymphomas showed EBV integration in the lymphoma cells.None of the Burkitt lymphoma biopsies had HIV by PCR. Of the 121 non Hodgkin B cell lymphoma patients with HIV test results, 19% had HIV. However, only 1(0.04%) case of Burkitt lymphoma had HIV. All the tumours were HHV8 negative. CONCLUSIONS The majority of the Burkitt lymphomas and two fifths of the diffuse large B cell lymphomas had EBV. All the tumours were HHV8 negative. Generally, the relationship of NHL and HIV was weaker than what has been reported from the developed countries. We discuss the role of these viruses in lymphomagenesis in light of current knowledge.
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Affiliation(s)
- Lynnette K Tumwine
- Department of Pathology, School of Biomedical Sciences, College of Health Sciences, Makerere University, P.O. Box 7072, Kampala, Uganda
| | - Jackson Orem
- Uganda Cancer Institute, Mulago Hospital, P.0.Box 3935, Kampala, Uganda
| | | | - Wilson Byarugaba
- Department of Pathology, School of Biomedical Sciences, College of Health Sciences, Makerere University, P.O. Box 7072, Kampala, Uganda
| | - Stefano A Pileri
- Unit of Hematopathology, Institute of Hematology and Clinical Oncology "L. & A. Seràgnoli", Bologna University School of Medicine, 40138 Bologna, Italy
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Audouin J, Diebold J, Nathwani B, Ishak E, Maclennan K, Mueller-Hermelink HK, Armitage JO, Weisenburger DD. Epstein-Barr virus and Hodgkin's lymphoma in Cairo, Egypt. J Hematop 2010; 3:11-8. [PMID: 21625283 DOI: 10.1007/s12308-010-0059-3] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2009] [Accepted: 04/16/2010] [Indexed: 11/26/2022] Open
Abstract
Fifty-five consecutive cases of Hodgkin's lymphoma (HL), collected between 1996 and 1998 from Cairo, Egypt, were histologically subtyped, phenotyped, and then studied for the presence of Epstein-Barr virus (EBV). We used immunohistochemical stains for EBV latent membrane protein 1 (LMP-1) and in situ hybridization stains for EBV-encoded small RNA (EBER-1) transcripts. Forty-five cases (82%) had classic HL (cHL), and ten cases (18%) had nodular lymphocyte predominant HL (NLPHL), with each group expressing its typical phenotype. LMP-1 stains were positive in 63% and 0% of cHL and NLPHL cases, respectively. EBER-positive Reed-Sternberg cells and variants were also present in 62% and 0% of each group, respectively. The cHL cases showed variable EBER positivity: nodular sclerosis, 58%; mixed cellularity, 100%; lymphocyte depletion, 100%; and unclassifiable, 67%. Our findings are similar to those from other developing countries and point towards a pathogenic role of EBV in cHL.
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Abstract
BACKGROUND HIV infection has been associated with an increased risk of malignancy, both AIDS defining and non-AIDS defining. METHODS This study presents a detailed pathological description of newly diagnosed lymphomas in Johannesburg, South Africa (January 2004 and December 2006). The review coincides with introduction of combination antiretroviral therapy. RESULTS One thousand eight hundred and ninety-seven new lymphoproliferative disorders were referred to the Charlotte Maxeke Johannesburg Academic Hospital. B-cell non-Hodgkin lymphoma accounted for 83%, T-cell non-Hodgkin lymphoma 3.5%, and Hodgkin lymphoma 7% of cases. The overall prevalence of HIV infection was 37% (n = 709). Diffuse large B-cell lymphoma (21%; n = 401) was the most common lymphoma. HIV prevalence ranged from an absence in follicular or mantle cell lymphoma to a low prevalence in diseases like small lymphocytic lymphoma/chronic lymphocytic leukemia (4%) and pre-B/common ALL (5%) to a high prevalence in diffuse large B-cell lymphoma (80%), Burkitt lymphoma/leukemia (86%), and primary effusion lymphoma (100%). CONCLUSIONS This study provides a baseline for monitoring the impact of HIV and management thereof on lymphoma trends. The high prevalence of HIV in certain lymphoma categories emphasizes the need for capacity to diagnose and manage dual conditions. This study highlights the need for strengthening of cancer registries within South Africa and the region.
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Tumwine LK, Agostinelli C, Campidelli C, Othieno E, Wabinga H, Righi S, Falini B, Piccaluga PP, Byarugaba W, Pileri SA. Immunohistochemical and other prognostic factors in B cell non Hodgkin lymphoma patients, Kampala, Uganda. BMC Clin Pathol 2009; 9:11. [PMID: 20003543 PMCID: PMC2805675 DOI: 10.1186/1472-6890-9-11] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2009] [Accepted: 12/16/2009] [Indexed: 11/20/2022] Open
Abstract
BACKGROUND Non Hodgkin lymphomas are the most common lymphomas in Uganda. Recent studies from developed countries have shown differences in survival for the different immunophenotypes. Such studies are lacking in Africa where diagnosis is largely dependent on morphology alone. We report immunohistochemical and other prognostic factors in B cell non Hodgkin lymphoma patients in Kampala, Uganda. METHODS Non Hodgkin lymphoma tissue blocks from the archives of the Department of Pathology, Makerere University College of Health Sciences, Kampala, Uganda, from 1991-2000, were sub typed using haematoxylin and eosin, Giemsa as well as immunohistochemistry. Using tissue micro array, 119 biopsies were subjected to: CD3, CD5, CD10, CD20, CD23, CD30, CD38, CD79a, CD138, Bcl-6, Bcl-2, IRTA-1, MUM1/IRF4, Bcl-1/cyclin D1, TdT, ALKc, and Ki-67/Mib1. Case notes were retrieved for: disease stage, chemotherapy courses received and retrospective follow up was done for survival. RESULTS Non Hodgkin B cell lymphomas comprised of Burkitt lymphoma [BL] (95/119) diffuse large B cell lymphoma (19/119), mantle cell lymphoma (4/119) and precursor B lymphoblastic lymphoma (1/119). For Burkitt lymphoma, good prognosis was associated with receiving chemotherapy, female gender and CD30 positivity. Only receiving chemotherapy remained significant after Cox regression analysis. Diffuse large B cell lymphomas with activated germinal centre B cell (GCB) pattern (CD10+/-, BCL-6+/-, MUM+/-, CD138+/-) had better survival (98.4 months; 95% CI 89.5 -107.3) than the others (57.3 months; 95% CI 35.5 - 79.0) p = 0.027 (log rank test). CONCLUSIONS Activated GCB diffuse large B cell lymphoma had a better prognosis than the others. For Burkitt lymphoma, not receiving chemotherapy carried a poor prognosis. Availability of chemotherapy in this resource limited setting is critical for survival of lymphoma patients.
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Affiliation(s)
- Lynnette K Tumwine
- Department of Pathology, Makerere University, College of Health Sciences, PO Box 7072, Kampala, Uganda
| | - Claudio Agostinelli
- Unit of Hematopathology, Department of Haematology and Oncological Sciences "L and A Seràgnoli"/Interdepartmental Centre for Cancer Research "G Prodi", Bologna University School of Medicine, Bologna, Italy
| | - Cristina Campidelli
- Unit of Hematopathology, Department of Haematology and Oncological Sciences "L and A Seràgnoli"/Interdepartmental Centre for Cancer Research "G Prodi", Bologna University School of Medicine, Bologna, Italy
| | - Emmanuel Othieno
- Department of Pathology, Makerere University, College of Health Sciences, PO Box 7072, Kampala, Uganda
| | - Henry Wabinga
- Department of Pathology, Makerere University, College of Health Sciences, PO Box 7072, Kampala, Uganda
| | - Simona Righi
- Unit of Hematopathology, Department of Haematology and Oncological Sciences "L and A Seràgnoli"/Interdepartmental Centre for Cancer Research "G Prodi", Bologna University School of Medicine, Bologna, Italy
| | - Brunangelo Falini
- Laboratory of Haematopathology, Institute of Haematology, Perugia University School of Medicine, Perugia, Italy
| | - Pier Paolo Piccaluga
- Unit of Hematopathology, Department of Haematology and Oncological Sciences "L and A Seràgnoli"/Interdepartmental Centre for Cancer Research "G Prodi", Bologna University School of Medicine, Bologna, Italy
| | - Wilson Byarugaba
- Department of Pathology, Makerere University, College of Health Sciences, PO Box 7072, Kampala, Uganda
| | - Stefano A Pileri
- Unit of Hematopathology, Department of Haematology and Oncological Sciences "L and A Seràgnoli"/Interdepartmental Centre for Cancer Research "G Prodi", Bologna University School of Medicine, Bologna, Italy
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13
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B-cell non-Hodgkin lymphomas in Uganda: an immunohistochemical appraisal on tissue microarray. Hum Pathol 2008; 39:817-23. [DOI: 10.1016/j.humpath.2007.10.025] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/23/2007] [Revised: 10/16/2007] [Accepted: 10/25/2007] [Indexed: 11/22/2022]
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14
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Meremikwu MM, Ehiri JE, Nkanga DG, Udoh EE, Ikpatt OF, Alaje EO. Socioeconomic constraints to effective management of Burkitt's lymphoma in south-eastern Nigeria. Trop Med Int Health 2005; 10:92-8. [PMID: 15655018 DOI: 10.1111/j.1365-3156.2004.01348.x] [Citation(s) in RCA: 47] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
This paper presents health outcomes and associated socioeconomic factors of 41 children admitted to a tertiary care institution in south-east Nigeria with Burkitt's lymphoma (BL) between 1987 and 2004. BL responds well to chemotherapy and does not pose a significant threat to health in industrialized nations. However, in resource-poor settings where it is endemic, socioeconomic factors significantly affect access to care for affected children, making this readily treatable condition a cause of considerable distress and early death in affected children. Half of the children reported in this paper presented with late stage disease. Although laboratory facilities were available, they were not accessible to all the children. Nearly a quarter of parents of these children could not afford the cost of confirmatory tests, and about a fifth (n = 8; 19.5%) of the children received no chemotherapy because of their parents' inability to pay. Only 21 of 41 children (51.2%) remained on treatment long enough (at least 12 weeks) to enable them to be confirmed either as short-term cure (n = 9; 64.3%), or as early relapse (n = 2; 4.9%). Owing to financial constraint, 13 of the parents (31.7%) withdrew their children against medical advice (n = 7; 17.1%) or left the hospital (n = 6; 14.6%). To address the challenge posed by these factors, we call for the establishment of a regional BL programme in Africa to help establish a critical mass of resources (human and material) to facilitate the development of an effective and accessible control programme in the region.
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Affiliation(s)
- M M Meremikwu
- Department of Paediatrics, University of Calabar Teaching Hospital, Calabar, Nigeria.
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15
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Abstract
PURPOSE OF REVIEW With the emergence of the highly active antiretroviral therapy era, it is apparent that the incidence of Kaposi sarcoma, in particular, and lymphoma in patients with AIDS is declining, especially in regions of the world where these regimens are routinely available. The burden of HIV infection and AIDS is greatest in the developing world, and no doubt neoplastic complications are increasingly encountered. The purpose of this review is to highlight recent developments of this aspect of the AIDS epidemic in the developing world. RECENT FINDINGS It was readily apparent that the incidence of Kaposi sarcoma sharply increased after the onset of the AIDS epidemic in developing countries. By the end of the second decade of the epidemic, non-Hodgkin lymphoma is increasing in incidence and the natural history of Burkitt lymphoma is evolving in the backdrop of HIV infection as well. Cervical cancer is the most common cancer in women in many developing countries, yet the true impact of HIV infection on the development of this neoplasm is not fully understood. Squamous cell carcinoma of the conjunctiva appears to be a unique AIDS-associated neoplasm that is encountered in sub-Saharan Africa as well. Finally, although the epidemiologic and clinicopathologic features for many AIDS-associated neoplasms are well characterized in developing regions of the world, there is a paucity of data on the therapeutic approach to these tumors in this setting. SUMMARY It is apparent that as the AIDS pandemic proceeds, the burden of neoplastic diseases is increasing in developing nations. Current therapeutic approaches are not well documented. Pragmatic prevention and therapeutic interventions suitable for the resource-constrained setting are clearly needed.
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Affiliation(s)
- Jackson Orem
- Uganda Cancer Institute, Mulago Hospital and the Makerere University School of Medicine, Kampala, Uganda
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16
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Karnik S, Srinivasan B, Nair S. Hodgkin's lymphoma: immunohistochemical features and its association with EBV LMP-1. Experience from a South Indian hospital. Pathology 2004; 35:207-11. [PMID: 14506963 DOI: 10.1080/0031302031000123164] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
AIMS Immunohistochemistry (IHC) is known to aid in the diagnosis of Hodgkin's lymphoma (HL). We studied HL using an antibody panel for Reed-Sternberg cells (RSCs) to find which antibody would be most useful for identification of RSCs. We also studied the association of Epstein-Barr virus (EBV) latent membrane protein-1 (LMP-1) with HL in South India. METHODS Lymph node biopsies of 100 cases of untreated HL were included in this study. Antibodies against CD15, CD30, CD3, CD20 (L26), CD45 (LCA), EMA and EBV LMP-1 were used for paraffin section IHC. RESULTS Of the 100 cases of HL, the RSCs stained with CD30 (93%), CD15 (67%), CD20 (17%) and CD3 (2%). EBV LMP-1 was positive in 82 (82%) cases, most often in the nodular sclerosis subtype, 43 (86%) cases. CONCLUSIONS (1) Of the panel of antibodies, CD30 was the most useful in identifying RSCs in classical HL. (2) EBV LMP-1 was demonstrated in 82% of all cases of HL and in 96% of childhood cases.
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Affiliation(s)
- Swapnil Karnik
- Department of Pathology, Christian Medical College and Hospital, Vellore, India.
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17
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Peh SC. Host ethnicity influences non-Hodgkin's lymphoma subtype frequency and Epstein-Barr virus association rate: the experience of a multi-ethnic patient population in Malaysia. Histopathology 2001; 38:458-65. [PMID: 11422484 DOI: 10.1046/j.1365-2559.2001.01104.x] [Citation(s) in RCA: 31] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
AIMS The pattern of malignant lymphoma is known to vary in different populations. This study aims to elucidate the effect of ethnicity on subtype frequency of non-Hodgkin's lymphoma and EBV association rate. METHODS AND RESULTS A total of 232 reconfirmed lymphoma cases in Malaysian patients were retrieved from the archives in the Department of Pathology, University Hospital, Kuala Lumpur. There were 24 (10%) Hodgkin's and 208 (90%) non-Hodgkin's lymphomas, 173 of the latter were in adult group (aged > or = 15 years). The ethnic composition were 41 Malays, 107 Chinese, 21 Indians and four none of the above. A male : female ratio of 2.4 : 1 was observed. Complete immunohistochemical studies in 158 cases revealed 36 (23%) T-cell, 121 (76%) B-cell and one (1%) null-cell phenotype. Seventy-five percent of the T-cell lymphomas were peripheral T/NK-cell types. Among the classifiable lesions, low-grade/indolent lymphomas constituted 17%: 2% were the lymphocytic subtype and 10% were follicular lymphomas. Approximately one-third of the follicular lymphomas occurred in Indian patients. The largest group of high-grade lymphoma was diffuse large B-cell type (46%), followed by peripheral T/NK-cell (18%). A predominance of NK/T-cell lymphomas occurred in Chinese (5/7), and all were EBV associated. Burkitt's lymphoma accounted for 5% (eight cases), all were Chinese males, with a 38% EBV-association rate. The frequency of EBV-associated B-cell lymphoma is three times more common in Chinese than Malays. The EBV positivity rate among lymphomas in ethnic Malay, Chinese and Indian patients was 5%, 15% and 22%, respectively, and in T- and B-cell lymphomas was 36% and 7%, respectively. CONCLUSIONS This Malaysian series reveals differences in the subtype frequencies of non-Hodgkin's lymphomas and EBV association rate amongst patients of various ethnic groups residing in the same environment.
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MESH Headings
- Adolescent
- Adult
- Child
- Epstein-Barr Virus Infections/ethnology
- Epstein-Barr Virus Infections/virology
- Female
- Herpesvirus 4, Human/genetics
- Humans
- In Situ Hybridization
- Lymphoma, B-Cell/ethnology
- Lymphoma, B-Cell/metabolism
- Lymphoma, B-Cell/virology
- Lymphoma, Non-Hodgkin/ethnology
- Lymphoma, Non-Hodgkin/virology
- Lymphoma, T-Cell/ethnology
- Lymphoma, T-Cell/metabolism
- Lymphoma, T-Cell/virology
- Malaysia/epidemiology
- Male
- Prevalence
- RNA, Viral/genetics
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Affiliation(s)
- S C Peh
- Department of Pathology, University of Malaya, 50603 Kuala Lumpur, Malaysia
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18
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Lazzi S, Ferrari F, Nyongo A, Palummo N, de Milito A, Zazzi M, Leoncini L, Luzi P, Tosi P. HIV-associated malignant lymphomas in Kenya (Equatorial Africa). Hum Pathol 1998; 29:1285-9. [PMID: 9824108 DOI: 10.1016/s0046-8177(98)90258-1] [Citation(s) in RCA: 41] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
The clinical and pathological features of acquired immune deficiency syndrome (AIDS)-related lymphomas, including their relationship with other viruses, such as Epstein-Barr virus (EBV) and human herpes virus-8 (HHV8), have been the subject of several studies from North America and Europe. No consistent data have been reported in Africa, where AIDS runs an epidemiological and clinical course different from that observed in Western countries. We retrospectively evaluated the presence of human immunodeficiency virus (HIV), HHV8, and EBV in 146 cases of malignant lymphomas collected in Kenya (Equatorial Africa), with the use of polymerase chain reaction (PCR) and in situ hybridization (ISH). The PCR technique confirmed HIV infection in 16 HIV-seropositive subjects (11%) and showed the presence of HIV sequences in five additional cases (3%) in which the occurrence of lymphoma was the only clinical manifestation. Our findings suggest that AIDS-related lymphomas are not pathogenetically homogenous, and different mechanisms may contribute to lymphomagenesis in these severely immunocompromised patients. In our series, no association of Hodgkin's disease (HD) with HIV infection could be shown. Among non-HIV-related lymphomas, EBV was present in 94% of Burkitt lymphoma (BL) occurring in patients younger than 15 years of age, in 87% of HD independently of age, sex, and histological types, in 60% of anaplastic large cell lymphoma (ALCL), and to a lesser extent (13%) in large B-cell lymphoma (LBCL) cases. Only one tumor, a case of HD, showed HHV8 by PCR.
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Affiliation(s)
- S Lazzi
- Institute of Pathologic Anatomy and Histology, University of Siena, Italy
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